The rotator cuff is a group of muscles which originate in the scapula and insert in the head of the humerus. As the head of the humerus sits on the very shallow glenoid fossa of the scapula, the muscles of the rotator cuff provide stability to the shoulder joint. Inflammation or irritation of their tendons commonly occurs in people who perform activities which require frequent lifting of the arm over the head, like painters, carpenters, athletes tennis players, swimmers and by frequently performing bench presses in the gym etc. This results in a constant pain over time in the shoulders which also restricts mobility of the joint, leading to a condition known as rotator cuff tendinitis or impingement syndrome. It is more commonly seen in people over the age of 40.
This is a case of a young boy, aged 17, who plays tennis at school and has developed exercise induced shoulder pains from repetitive stress. His mother and I are members of a common organization and know each other from earlier. She brings him in to see if homeopathy can provide any better relief for his condition. He appears to be serious, calm, and overall a well-behaved teenager. To me he also seemed like someone who is touchy but holds his feelings inside. I usually keep bottled water at my office for patient’s and what was peculiar here was he gulped down a liter of water in the course of our consultation which might have lasted about an hour and a half.
The case is presented ad verbatim:
My eyes are dry, on waking up in the morning, so dry that when I try to open my eyes I can’t. I have to close my eyes and wait. I feel tiredness in the eyes. I wear contacts through the day, and as the day goes by it feels more tired. Been wearing contacts for 4 years. I didn’t have tiredness back then, now even in the morning on waking I have the tiredness. My eyes get tired through the day as well. This tiredness started about 2-3 weeks ago. When I say tired, I mean it’s so dry that I can’t keep my eyes open. Once my eyes adjust, I am fine. I put on my contacts and I am fine.
Sometimes I feel I can’t get enough breath in my lungs, and I feel it even if I inhale deeply. I have to inhale deeply and calm my lungs down. It’s been going on for long. I feel I am not able to get enough air. It happens at random. Lung test reports were normal. When shortness of breath happens, I feel lot of saliva secretes then and I have to keep swallowing. Sometimes I would feel I will throw up. I have to blow air out instead of breathing in and then I start coughing and I feel I will throw up. When I have a bowel movement after that I am fine. Randomly happens. It is after I wake up and eat something, not every day, today it happened.
I have to drink a lot more water than I need to. On the days when I drink less it feels uncomfortable at the back of my mouth, in the throat. It’s happening right now, when I breath through my nose it gets irritated. If I drink water, it is less irritated.
M- Regarding drinking too much water, the tests show he is pre-diabetic. Recently another blood test showed everything was okay.
I usually drink a liter of water before going to bed and if not, I wake up thirsty in the middle of the night. Water at room temperature. My right shoulder is inflamed where my lats are. Doctors said it is due to rotator cuff injury.
M- He plays tennis and the repetitive shoulder motion caused it last year. The doctor suggested some physical therapy. It has not degraded too much but not improved either. X rays show its okay, no problem in the bones, they feel it is an inflammation and have prescribed ibuprofen, on it for a week now. It has been going on for one year.
P- I feel it’s more in the past one month. I stopped playing tennis now, I play for my school.
M- He did play a few months back. They must play 3 hours after school every day, it’s top level tennis. He is one of the good players.
P- I was never planning to go professional anyway. We don’t have to practice after the season. I just want to play for a few years in college that’s it. When I raise my arm, I feel tightness in the arm pit. Moving my arm forward and parallel to my body it is in the upper shoulder. If I reach something up it starts to pain. Axilla pain is tightness and throbbing if I try to stretch it. Upper shoulder is sharp, like a pin pointed pain (Tries it out to see if it hurts). No changes seasonally. The pain is fairly consistent unless I try to overstretch myself. The other left shoulder I hear a sound when I move it, and normally that doesn’t bother me, but when I do tennis serves it bothers me. It feels like a soreness, it lasts for some time after the serves. This is only when I play tennis.
I have tightness on both sides of the neck that restricts my movements both sides and all directions. Icing doesn’t give any relief. I have tried heating pads on my shoulders and that didn’t seem to make any difference either. When I walk my left ankle makes a cracking sound and it doesn’t hurt. My right wrist also feels tight when I try to extend my fingers.
I am hard working, study a lot and spend a lot of time on Facebook and Messenger. I speak 5-6 hours every weekday. I am either studying or talking to friends.
I have a few close friends. I have a lot of regular friends and I have a few close ones. I am a very caring person. I try to look out for everyone even if they are not close to me Eg. One of my friend gets very angry with himself and starts crying so I hug him and I try to figure out what his problems are and give him advice. I try to give them advice and they can mold the advice into what they want to do. I volunteer about 6 hours a week in a day care after school. I help elementary schoolers doing their homework and play with them. My brother got me into it when he graduated, I enjoy it. It’s nice being around kids’ cos they are very innocent, and not filled with stress yet. I have stress at school, college applications, SAT’s.
M- He is in 12th now and he must apply to various colleges.
P- I am trying to get into UCLA. I am not that ambitious. I am somewhat lacking in drive. I don’t know what my goal is right now. I want to do something in computer science, but I am not sure how to go about with it. I try to enjoy myself when I am playing tennis, I am somewhat competitive. If I lost, I try to see what I can do to improve. I try to think of innovative and creative ways to solve each problem. How to solve problems in programming.
I am afraid of spiders, failure. I am afraid I may fail. I should be more driven by success but instead I am driven by failure. I am trying to change my mindset. I don’t necessarily feel guilty about it. It’s not something that haunts me. I am more irritable when I am tired or dehydrated but usually I am very calm. I
will raise my voice a little but don’t yell. I hold somethings to myself and somethings I share. I don’t discuss personal problems. (He becomes quiet so mom voluntarily goes out to give him space) I haven’t discussed this as much with my parents. When I was a sophomore, I felt the pressure of constantly being compared to my brother and couldn’t. I decided to not compare myself with him and try to focus on what I want to be. I was very sensitive about it. I had constantly spent the first 16 years of my life being compared to him, because he was 3 years older to me. He always had an edge over me and teachers always compared us, like you are so similar. When I couldn’t live up to it, they stopped. At school, they compared me, but I took it as a joke. I felt angry with myself that I couldn’t live up to their expectations.
I haven’t discussed with my parents either. In first junior year I had a girlfriend, I was 16 years old. Dating happened in the first semester of my junior year. We did go to our homecoming at school. She broke up with me the last day of finals. I felt angry at myself I couldn’t help her with her problems. I still liked her, and I asked her if we could continue after summer, we stopped liking each other after that. I still think about her but not in the same way anymore. I was also angry at her for not being able to keep the relationship alive. The relationship took a toll on me and I couldn’t move on for some time, I guess I am a very emotionally attached person and after that I was fine. I am not sure if parents would approve of me having a girlfriend. They are somewhat strict, but they think it will come in the way of my studies, they allow me to do things too.
I am emotional but I also have a logical part to me. I try to control myself. I haven’t told anyone immediately when I liked them. Even in the relationship she asked me out first. I crave Cheetos, I like it more because of the crunch and spice. I don’t eat sweet foods as much anymore. I am tolerant to both heat and cold. I can roam around in shorts and T shirts. I get occasional headaches in the sun. Hot weather I am tolerant, I have played tennis in 100 F before also.
M- He has had bronchitis once in childhood. He had purpura, rashes on his legs when he was in kindergarten. He had warts on his fingers when he was very young.
(He gulps down two 500 ml bottles of water here in the office)
D/D of Remedies
The theme seen throughout are complaints coming on from overstraining, especially the muscles and tendons. There also seems to be rigidity of these muscles, including those of the shoulder joints, the eyes and even of the chest to the point he struggles to get a breath at times.
The main remedies which came to my mind as options were:
Bryonia alba– Great thirst for large quantities of water, usually at long intervals with dryness of mucus membranes. Inflammation of joints with swelling and stiffness. Mentally though, Bryonia types tend to be loners, extremely irritable and do not want to be disturbed which doesn’t suit his profile of personality.
Natrum muriaticum as he is well behaved, responsible, not easily discussing his emotions with his family or friends and is quiet, mature and serious for a teenager his age. It is a big remedy for dryness of the eyes and can have great thirst. It is not specifically a remedy targeted for muscle, tendon and joint injuries though it does cover them on repertorization.
Rhus toxicodendron – Well known for rheumatic complaints, stiffness, rigidity of muscles and joints. Complaints coming on from over exertion, better from rest and warmth. They have a strong reaction to weather changes, especially to cold and wet. Tendency to have skin related issues like urticaria, herpes and allergic dermatitis. They tend to be very disciplined in life and are rigid even in their personality.
Ruta graveolens – Complaints brought on from overstraining of parts. Well known rheumatic remedy, stiffness of parts with loss of elasticity of muscles and tendons. Big remedy for complaints from overstraining the eyes muscles, disturbances of accommodation. They can have a violent unquenchable thirst. On the mental level, they tend to be melancholic by nature, don’t talk about themselves too much. They can be extremely competitive initially but later they avoid competition knowing that there is someone out there who is always better than them (in this case his brother with whom he is constantly compared), so they go into less competitive arena’s eventually. There is a need to be admired by the society in the family of Rutaceae to which Ruta belongs; like him volunteering after school in a daycare and helping the kids out there to get admiration from the people around him.
Based on these comparisons, Ruta seemed to be the best choice. My back up options were Rhus tox or Natrum mur, if Ruta doesn’t have the desired effect.
Remedy prescribed: Ruta graveolens LM1
Follow up after a month and half. Comes in with his mom.
My shoulder seems to be getting better, not sure whether it is due to PT or the meds. There is a decrease in swelling, it doesn’t hurt to raise my arm anymore, doesn’t tighten up in that area. It was gradual improvement. The swelling really didn’t decrease till one or two weeks ago. My eyes are still dry. My neck and back are still the same.
When I don’t drink enough water, my nose feels blocked. I have to drink a liter of water before I go to bed. I am not thirsty anymore, but I still need the same amount of water. I don’t feel the urge to drink that much water now, I have to drink it though. (Seems to be doing it out of habit) My eyes don’t seem to be so tired at night. There is an improvement in that sense. 20-30% better. (Grabs a bottle of water, says he is thirsty)
I have been getting good sleep this week, as I have a break in school. In the previous weeks not much sleep. I feel more energetic overall when I sleep less. I don’t have as much patience anymore. Last time I said I wanted to help people as much as possible, now I am less inclined to help people who don’t want to help themselves. I am tired of people having that mindset in high school. I think that its disappointment that people don’t want to help themselves. I feel like that since the past one month or so. My temper also aligns itself. I still have the same patience, but I don’t want to use it for everyone. I have patience to listen to my friends for hours but not to people who don’t want to help themselves. I have to apply to colleges now, in the first semester it’s going to be stressful. From December onwards, it will be less stressful as I would have finished applying for these colleges.
My interpretation– There is obvious improvement of his complaints, though not completely gone. The shift in his emotional state is also interesting, as Ruta has this need for social admiration, where they want to be praised for all the causes they have volunteered for. He says that he doesn’t want to help people who don’t want to help themselves anymore. He is indicating that now he only wants to focus on volunteering for genuine issues and for people who really need help. The focus on his own social recognition has come down, which was subconsciously causing a lot of stress in the past.
Wait on the same remedy
His mother cancelled the subsequent follow up as he was doing much better and they didn’t have much to report. I have met his mother in social settings a few times and she mentioned he was doing very well overall. He left home to study in a university, a year down the line.